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The People’s Pharmacy: Treating nail fungus is costly

How much are you willing to spend to get rid of nail fungus? Granted, fungus-ridden nails are unsightly and hard to trim, but for most people, they are not a serious health problem. Nevertheless, drug companies charge a lot of money for medications that offer modest results.

Television ads for efinaconazole (Jublia) feature a cartoon toe playing tennis, boxing or tackling toenail fungus in a football helmet. What the ads don’t say is how much Jublia costs or how effective it is. According to the label, it will take 48 weeks of daily applications to achieve a complete cure in 15.2 to 17.8 percent of the people using it.

What’s that worth? One reader sent us the following message:

“I’ve had toenail fungus for more than 20 years. Sporanox offered limited success, so I figured I would try Jublia due to the ubiquitous commercials shown on TV.

“Once I got a coupon waiving the copayment, I asked my doctor to prescribe it. He agreed, but when I went to the pharmacy, they said it would take a day to get the large size and preapproval from my prescription plan. When I picked it up, the Jublia was in a tiny 8 ml bottle. There are only 20 drops in a milliliter, and therefore the entire bottle should only have 160 drops.

“I read that I need one drop per toe per day; that’s 10 drops a day, and therefore the 160-drop bottle should last about 16 days. I figure about two bottles per month. If the treatment time frame is 10 months, then one would need almost 20 refills.

“Then I looked up the pricing for Jublia, and the cost ranged from $1,082 at Walmart to $1,187 at my Rite Aid. So it would cost roughly $22,000 for the full treatment that offers a complete cure rate of 17.8 percent. That’s absolutely ridiculous!

“I then calculated the cost of the efinaconazole active ingredient. Estimating the active ingredient at 10 percent solution and 8 ml in my bottle at $1,187, the active ingredient is only 0.8 ml. That makes the price of this drug far more than gold.

“Canadian online pharmacies charge around $20/ml, so my 8 ml bottle would cost roughly $160. Here in the U.S., we pay 7.4 times as much. I am embarrassed that I cost my drug plan that kind of money, and I will not be refilling this prescription.”

Home remedies are rarely tested in controlled trials, and the Food and Drug Administration does not approve them. They are, however, far less expensive than prescription antifungal medicines. Readers report surprising success with a variety of such approaches.

One person offers this formula: “Put about an inch of cornmeal in a plastic dishpan. Pour in hot water, stir it so the cornmeal gets dissolved, and when it is cool enough not to hurt, soak your feet for an hour. Done regularly, this will get rid of the fungus.”

Another reader tells about her experience: “My toenail fungus has affected all my nails, and on four nails, it’s very bad. I have been soaking my feet in a 50/50 mixture of Listerine and vinegar for about a month, and for the first time, I’m actually seeing progress. I had tried many expensive products previously, with absolutely no luck! I soak 30 minutes twice a day. I’m not out of the woods yet, but my daughter agrees that the fungus seems to be retreating.”

Anyone who would like to learn about other remedies may find our Guide to Hair and Nail Care helpful.

It can be downloaded for $2 at

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. Email them via their website: